=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841679610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFECARE SOLUTIONS PALLIATIVE AND HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2015
-----------------------------------------------------
Last Update Date | 07/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7567 AMADOR VALLEY BLVD STE 101
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94568-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-573-2523
-----------------------------------------------------
Fax | 877-217-7087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39675 CEDAR BLVD SUITE 240 B
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94560-5489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-573-2523
-----------------------------------------------------
Fax | 187-721-7708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMIN
-----------------------------------------------------
Name | MR. ANDRO BAUTISTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-573-2523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------